Pre-existing soft tissue/joint injuries

About 1/3 of the clients I have deal with some type of pre-existing soft tissue/joint injuries. These injuries are either seen during assessment, exposed during exercise (then clients admits to having prior injury), or expressed by client during consultation. I try to target the area with different exercises during warm-up/prehab to help strengthen the joint/muscle using corrective exercises. Some of the injuries affect basic movement patterns limiting exercise program/progression. I recommend clients to see PT to help injuries if they are not already doing so but some cannot afford, don't want to see a PT for whatever confidential reason, or have a reason/excuse why they can not go. How do you handle these types of situations/clients? Anything you can recommend?

Answers (12)

If it is a known injury and there has been PT, I'll try to contact the PT if issue arise that seem to be in conjunction with the problem.

If I find a problem during the assessment (and sometimes clients have not been aware because they simply stopped moving in certain ways), I MAY carefully work around until I have a clearer picture. If things get better, great. If there is pain or no improvement, I refer.

I really did not have a situation where people refused to see a doctor and/or PT. If that ever happened, I may continue to train them in a way, that I would completely avoid that part of the body unless it was the lower back when I would stop training them.

Personally, I feel that if people can afford personal training, they can afford a doctor. Ultimately, it's more a question whether they can afford, NOT to see one.

You have to repeat a few times that they have to visit doctor, not PT, you have to asking them to sign a release, and you have to perform initial assessment, and collect information about your client. Insurance a must, of course. After that you have to repeat again that they have to visit a doctor and ...train them!

I agree with Miroslava. It depends on the case, sometimes when a physician prescribes them to a PT, their insurance can pick up the tab (they could verify this with their insurance). The physician and/or the PT can suggest to them to see a Muscle Activation Therapist, who in my opinion can be more effective than a PT. The other option is for you to consult with their physician about their injuries and if they have a medical release by them, you could design a program that works around those soft tissue injuries and help them recover in a safe way. In some cases they might not have an alternative other than see a physician before they can start working out.

WOW...
how is it that you wound up with this bunch? Are you not comfortable working with individuals w/preexisting injuries?

My opinion:

When i 1st started working in large gym setting's & even as i moved through the ranks to management, upper management always like to give me the injuries, more mature or problematic clients.

I took this as a challenge to learn more about their aliments & what would be most effective & safe for them "IN MY CARE." As frustrating as I remember this being to me as I am an active, big mouth, INNERGY ball. ex: ROADRUNNER made to feel like Tommy the turtle after 8 or so hours of training/coaching...

What I remember is, when i changed MY opinion of the situation more benefit was had all around. The clients I helped got the assistance they needed!!! If it was rehabilitation, I studied, practiced & bounced ideas off of PT friends for more peace of mind...

In corrective work, I offer what is needed and as always challenge whoever to produce the what "I am looking for" but, need I them to be receptive & engaged enough to notice/feel what I am trying to get @ with the exercise & communicate w/me...

I take the stance of "COACH," and relate to whomever that that they are here to learn and be assisted in their development. Not every one agrees with some of my approaches but, I promise, I have NEVER had a special needs client leave!!! If they are hesitant or resist, I try to approach from the angle of least resistance (mentally).

My point is stud, I make sure they know I have their best interest @ heart PERIOD!!! I don't care if they want to flip & jump for the duration of the session, if it can't be accomplished in what I feel is a safe manner & it does nothing to enhance the program, scrap it...

As they progress, and they should, you will be more than the hero. You will be the "professional, the friend, the educator & most of all the one who cared enough..."

If I look at my certifications, I have a defined scope of practice. I know what I can and cannot do, but I also honor what - by the certifications I hold - I must not do. I will jump through hoops for my clients and educate myself as well as I can on whatever ails them but I will not move ahead unless I have a diagnosis and release from a physician, as appropriate.

Karin highlights some great points: "it depends" on the situation and I believe that "if people can afford personal training, they can afford a doctor."

Also, much like Jabez, I see these opportunities as a "challenge to learn more about their aliments & what would be most effective & safe for them." I'm sure to always stay within my scope of practice but that doesn't mean I automatically refer prospective/new clients out to a doctor/PT/etc. if they have faulty movement patterns.

I feel that a big part of my job as a trainer (especially since I'm a NASM certified Corrective Exercise Specialist) is to provide a more welcoming alternative to the typical relationship a "patient" has with their "practitioner."

Just to be clear, I'm not saying that doctors or PTs don't care about the people coming in to see them. However, I've heard numerous stories from clients about how they've had "get them in and get them out" experiences with various practitioners they've gone to over the years.

Perhaps the client expected too much, or perhaps they were given too little. Depending on the circumstance I bet an argument could be made for one or both.

Assuming the benefits outweigh the risks of helping someone begin the (never-ending) journey towards healthier living, I'll start them on an appropriate program ASAP. After building up rapport with a client they're usually much more receptive to any kind of recommendation/referral I make. I take the time to help them understand how - for instance - seeing an Active Release Techniques Therapist will assist them in achieving their goals in a more efficient way.

Does all this make sense? Let me know if I need to clarify anything and I'd be more than happy to do so.

Regardless, best of luck to you with "these types of situations/clients!"

This is when you must go with your gut and do what you know is best for the client as well as yourself. If you feel strongly about something, then let the client know that it is their health you are concerned about. Is that not the reason they see you?...for the professional help?

On the other hand, I have seen and heard about physical therapy done by understaffed or overbooked appointments, I don't know why. Whatever the reason, the clients' experiences were not in the safest environments. We never know why someone chooses what they do unless we see it with our own eyes or the client honestly opens up.

At some point we've all had clients such as these. Most clients who are active, have had or will have a soft tissue or joint injury. Some do no cause any lasting effects, others do.

As you said, I do my best to try to get the person to see their physician or a physical therapist. If they have already done this, I ask what type of exercises they were told to do or what therapy were they told to continue.

Many clients who have seen a physical therapist believe that their work is done once therapy is over. But as we know, either from insurance issues, time constraints on the side of the therapist or client or the client "feeling" better, therapy may have been discontinued before the injury site was completely healed or rehabilitated to the point of normal, full activity. As the physical therapist I work with often tells me, "My job is to get them to the point of a return to activity. That doesn't mean that the site is ready to handle "all" activities yet. That client still has strength work, flexibility work and ROM work to do on their own."

Just as we give homework to our clients and some do it and some don't, the same goes for physical therapy and rehabilitation work.

In those cases, I have the client demonstrate the exercises they were doing with the therapist or given to do on their own. I may incorporate some of these into the workout till the area is strong, flexible, etc enough to progress to something else. Or I go back to basic exercises, starting with isometrics and limited ROM, then progress as the area performs in a correct allignment. If I have an opportunity to talk to the therapist, that's even better, but that is not always possible.

As others stated, I also use it as an opportunity to hone up my research and knowledge on that injury, the muscles affected and common rehab approaches. I talk to other qualified people, do internet searches, look through my manuals/books/journals, etc. Then I start slow and see how it goes.

Good luck with these tricky clients and take it as a great opportunity for growth.

Soft tissue damage is so broad. As a professional, you know your expertise and your professional limitations, follow this knowing. Having said that we all deal with soft tissue joint issues. We know that RICE is important and we all understand overuse syndromes. We understand the importance of strengthening weak muscles that can cause misallignments, and stretching tight muscles that can show up as pain or discomfort.

A great trainer is a critical thinker. She/he takes into consideration all of these components, and more, when deciding on the best protocol. This is the art of personal training.

I think all the ways that you could answer this question really have been addressed.

I mean, as long as we are in the business of getting to people to move, you must educate yourself. Obviously you need to know your scope but also must be able to speak the same language as the proper referral, if needed. With that being said, you want clients, you need clients and you don't want to hurt clients many which are already suffering with some kind of pains. I really think that it is your responsibility to know what you can and cannot address and that needs to communicated effectively with your client.

For example if you determine that your client has a fallen arch, yet runs ten miles a week and complains of feet pains in the arch, it is well within your scope to tell them they need to STOP running and follow through with the correct stretching protocol you advise, so that you can get them back to exercising in the gym with you.

It really comes down to knowing your craft. You don't want to have to refer out if you don't have to but you need to command the respect that professionals of any craft do.